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Child marriages increase risk of childbirth injuries

Child bride Krishna, 12, poses for a photograph as her husband Kishan Gopal, 14, stands behind her outside her house in a village near Baran, located in the northwestern state of Rajasthan, in this July 30, 2011 photo. The legal age for marriage in India is 18, but weddings like these are common, especially in poor, rural areas where girls in particular are married off young. Child marriage, which steals the innocence of millions of girls worldwide and often condemns them to lives of poverty, ignorance and poor health, is one of the biggest obstacles to development, rights groups say. Horrific childbirth injuries are just some of the devastating consequences of child marriage.
(DANISH SIDDIQUI / REUTERS)

Thu., Aug. 4, 2011

NAIROBI—“Nobody wants a woman who passes stools all the time and smells,” whispered Farhiya Mohamed Farah, explaining why her husband divorced her when she was pregnant with their second child.

Farah, developed a hole between her vagina and rectum, causing feces to leak from her body, after giving birth to her first child at age 18 while fleeing gunfire in Somalia.

“People would ask who is making that bad smell, coughing and covering their noses. So I was always isolating myself,” she said.

The condition, known as fistula, affects 2 million women around the world, mostly in Africa, according to the World Health Organization.

Fistula was virtually eradicated in developed countries in the 19th century, following the discovery of caesarean section.

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Horrific childbirth injuries are just some of the devastating consequences of child marriage.

Child marriage, which steals the innocence of millions of girls worldwide and often condemns them to lives of poverty, ignorance and poor health, is one of the biggest obstacles to development, rights groups say.

A girl under the age of 18 is married every three seconds — that’s 10 million each year — often without her consent and sometimes to a much older man, according to the children’s charity Plan UK. Most of those marriages take place in Africa, the Middle East or South Asia.

The UN Convention on the Rights of the Child considers marriage before the age of 18 a human rights violation.

Girls aged 15-19 are twice as likely to die in pregnancy or childbirth than women aged 20-24, according to the United Nations.

“Pregnancy at an early age is a huge risk factor for obstructed labour, as a girl’s body has not fully matured and the pelvis is small,” said Kate de Rivero of the Women and Health Alliance, a charity working to improve maternal health.

Apart from the biological risks, girls who marry at a young age do not have the power to make decisions about their own bodies, including on how and where to give birth.

“Decisions on when and where women can give birth are made either by their husbands or by their mothers-in-law,” said Agnes Odhiambo, a women’s rights researcher with Human Rights Watch.

“Rarely do those poor, uneducated rural women have a voice to stand up and say: ‘No, I want to go to hospital.’ ”

Farah was too poor to buy sanitary pads, so she stuffed her underwear with rags. But feces still leaked onto her clothes, forcing her to wash them several times a day. She doused herself in perfume to hide the smell.

A midwife tried to suture the hole four times, without success.

“I was thinking that the rest of my life would be like this until I died,” said Farah, now 20, her birdlike frame shrouded in a red headscarf and skirt.

Farah found relief in June at Kenyatta National Hospital’s 15-day “fistula camp,” where 102 patients from all over Kenya had surgery for free.

“It’s an unparalleled type of transformation,” said Khisia Wakasiaka, the lead surgeon. “They move away from total neglect to somebody with some hope in life.”

Community midwives who educate people in the villages have proven effective in reducing maternal death rates.

“If you are able to monitor these women closely in labour and intervene when it’s required, then the risk of fistula formation is reduced markedly,” Wakasiaka said.

About 70 per cent of women living with fistula never seek treatment because they don’t know what is wrong with them.

“There are all these myths that go on in the communities: you are promiscuous, you are bewitched or you have HIV,” said Odhiambo. “Because it’s stigmatized, you are really ashamed to speak up about it.”

A survey of nine African countries by the UN Population Fund in 2003 found that most fistula patients were poor, uneducated teenagers who developed a fistula while giving birth to their first child. Some were as young as 12.

Girls forced into early marriage rarely continue their education, denying them any hope of independence, the ability to earn a livelihood or of making an economic contribution to their households.

Girls who complete secondary school are six times less likely to become child brides than contemporaries with less or no education, according to the ICRW, a Washington-based think tank.

The practice also reinforces the concept of girls as worthless burdens on their families to be jettisoned as soon as possible.

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